Provider Demographics
NPI:1306814264
Name:PETERMAN, ANGELA RUTH (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RUTH
Last Name:PETERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 RIDGELY AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1001
Mailing Address - Country:US
Mailing Address - Phone:410-224-7795
Mailing Address - Fax:410-224-5826
Practice Address - Street 1:600 RIDGELY AVE
Practice Address - Street 2:SUITE 123
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1001
Practice Address - Country:US
Practice Address - Phone:410-224-3614
Practice Address - Fax:410-224-5836
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0029734174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KK85HN40Medicare ID - Type Unspecified
MDD73824Medicare UPIN